Provider Demographics
NPI:1831175009
Name:SPERO, MARC (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:SPERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E 55TH ST
Mailing Address - Street 2:17TH FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4540
Mailing Address - Country:US
Mailing Address - Phone:212-355-8315
Mailing Address - Fax:212-355-9741
Practice Address - Street 1:110 E 55TH ST
Practice Address - Street 2:17TH FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4540
Practice Address - Country:US
Practice Address - Phone:212-355-8315
Practice Address - Fax:212-355-9741
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120781173000000X, 207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No173000000XOther Service ProvidersLegal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00737191Medicaid
NY673911Medicare ID - Type Unspecified
NYC11708Medicare UPIN